​Marc Lewis-the guardianNever mind the ‘war on drugs’ or laying all blame with pharmas, this epidemic exists because millions live in a world without hope, certainty and structure

• Marc Lewis is a neuroscientist and author of The Biology of Desire: Why Addiction Is Not a Disease

The number one killer of Americans under the age of 50 isn’t cancer, or suicide, or road traffic accidents. It’s drug overdoses. They have quadrupled since 1999. More than 52,000 Americans died from drug overdoses last year. Even in the UK, where illegal drug use is on the decline, overdose deaths are peaking, having grown by 10% from 2015 to 2016 alone. The “war on drugs” continues – but it’s a war we’re losing.Most drug-related deaths result from the use of opioids, the molecules that are marketed as painkillers by pharmaceutical companies and heroin by drug lords. Opioids, whatever their source, bond with receptors all over our bodies. Opioid receptors evolved to protect us from panic, anxiety and pain – a considerate move by the oft-callous forces of evolution. But the gentle impact of natural opioids, produced by our own bodies, resembles a summer breeze compared to the hurricane of physiological disruption caused by drugs designed to mimic their function.Most street opiates (including heroin) are now laced or replaced with fentanyl – the drug that killed the singer Prince – and its analogues, far more powerful than heroin and so cheap that drug-dealing profits are skyrocketing at about the same rate as overdose deaths. The UK’s National Crime Agency said that traces of fentanyl have been found in 46 people who died this year. Users don’t know what they’re getting and they take too much. Fentanyl is recognised as a primary driver of the overdose epidemic.Dozens of UK drug deaths linked to opioid that killed singer PrinceSociety’s response has been understandably desperate but generally wrongheaded. We start by blaming addicts. Then we blame the pharmaceutical companies for developing and marketing painkillers. We blame doctors, for overprescribing opiates, which pressures them to underprescribe, which drives patients to street drugs – cheaper, home delivery via the internet, and zero quality control. We say we’re going to reignite the war on drugs, recognised by experts as a colossal failure from the 1930s onward. We also continue to view addiction as a chronic brain disease, so the benefits of education, social support, psychological intervention, and personal empowerment receive far too little attention. Yes, addiction involves brain change, but ongoing medicalisation does little to combat it.There has been some progress: There are pockets of activity here and there where prescribed opiates – like methadone and Suboxone – are made more easily available to addicts. That’s a good thing, because increasingly desperate addicts are often driven to the street, where they’re most likely die. The availability of naloxone, which works as an antidote, is slowly wending its way through the drug policy jungle, providing a simple resource to deal with an overdose on the spot. But in most segments of most communities in the US and elsewhere, it is still too difficult to obtain.There are smarter answers at hand – but also smarter questions to be asked. The overdose epidemic compels us to face one of the darkest corners of modern human experience head on, to stop wasting time blaming the players and start looking directly at the source of the problem. What does it feel like to be a youngish human growing up in the early 21st century? Why are we so stressed out that our internal supply of opioids isn’t enough?

Developed by the NYSDOH AI Hepatitis C Virus Infection Guideline Committee, this guideline provides clinicians in New York State with the information and evidence-based recommendations they need to treat patients with chronic HCV infection.

The availability of safe and effective oral DAA regimens has revolutionized HCV care for many people with chronic HCV infection. To benefit from treatment, candidates must be: screened for and diagnosed with HCV infection, engaged in care, and have access to treatment that is managed by an informed clinician. Toward that end, this new guideline covers all aspects of HCV care, with the aims of increasing the use of curative DAA therapies among NYS residents living with HCV infection and reducing the growing burden of mortality associated with chronic HCV infection.

Following the federal government's announcement that approval for supervised drug-injection sites would be made more obtainable, the Sandy Hill Community Health Centre (SHCHC) in Ottawa became one of the first to submit an application. After receiving confirmation provincial funding would be provided earlier this year, the centre is anxiously awaiting final federal approval.I visited the SHCHC to speak with Rob Boyd. He is a former Orillia resident, and director of the Oasis Program largely responsible for the SHCHC's drug-treatment services. We sat down, in the room where the supervised injection site is planned to be established, to discuss what will be the centre's newest initiative."Once we have our injection service up and running "¦ people will be able to connect with case-management services, they'll be able to go to the drop in afterwards to connect with the staff, and go to the clinic if they have any other health concerns. Or, if the nurse who's in here identifies something that they might want to have checked out, they will immediately be able to connect with the primary care services; they are going to be available right across the hall," Boyd said.When consuming hard drugs on the street, away from medical care, users can put themselves at high risk of overdose and death. By promoting safer drug use on location, emergencies will be less common and handled more swiftly. Additionally, users would be exposed to a host of services that could help to treat their addiction and other medical and socioeconomic problems.It was also clear from our conversation that in order to deal with this problem effectively in Canada, focus needed to be put on managing and decreasing use, not just eliminating it."Very few people actually achieve abstinence. But, to make that the goal for everybody actually sets people up for failure "¦ So, this idea that we have to completely eradicate drug use, it's not even an aspirational goal; it's a delusional goal."Drug use is a reality our society will always face. If we are to deal with drug use in a meaningful way, we need to change our approach to it.